EXOPHTHALMOS RELATED TO ENDOCRINE DISTURBANCE

Wu Zesen, Jin Shubai, Zhang Shiyi, Gui Jinshui

(Shanghai Institute of Acpuncture and Meridian, Shanghai)

This paper deals with the observation of therapeutic effects achieved by acupuncture alone in the treatment of exophthalmos of endocrine origin using the data obtained by ultrasonic examination (type A and B) and exophthalmometry as the chief indices for analysis- A preliminary hypothesis of the mechanism of this mode of therapy is suggested and discussed.

Subjects and Methods: All the patients were referred to us by specialized thyroid clinics, whose serum T3, T4, and BMR approached normal, but whose exophthalmos remained greater than 18 mm and retrobulbar spacereater than 13.5mm. The disease course was more than 1 year in all cases, 40% of which was more than 5 years, the longest being more than 10 years.

Acupuncture was the sole treatment instituted. It was given 3 times a week, and the patients were observed for 12 months. The main point adopted were Supra-Tianzhu (5 feng above Tianzhu) Fengchi, and inductive manipulation was used. Particular emphasis was laid on the needling sensation, and it was demanded that "the Qi should reach the site of ailment". Reinforcement was employed for the point Zusanii and Sanyinjiao. The accessory point chosen were Sizhukong, Yangbai, and Zanzhu, each of which was punctured through to the point Yuyao. Three needles were applied simultaneously. Additional points were selected for supplementation if other symptoms and signs were present. The point on the limbs were reinforced and reduced by lifting and thrusting of the needles, and retained for 30 minutes.

Results: The therapeutic effects were judged by ultrasonic measurement of retrobulbar space, degree of exophthalmos, as well as comparing the eye symptoms, eye signs, and change of exophthalmos grading before and with those after treatment.

Retrobulbar space reduction occurred in 82%, 26% of which returned to normal.

Effectiveness as indicated by exophthalmometry was 66%, and the recovery rate was 21%. Not a single case of aggravation regarding these two indices was encountered after treatment.

All ocular symptoms showed improvement to a greater or lesser extent after acupuncture treatment, and disappeared completely in 64%, with the eye signs essentially controlled.

The exophthalmos was graded according to the criteria of the American Thyroid Association, and those of Kuan's method advocated in China. Analysis of the data gave significant difference (P<0.01) before and after treatment.

Relation Between exophthalmos and circulatory stasis: After differentiation of symptoms and signs according to the theories of Chinese traditional medicine, it was discovered that systemic and ocular circulatory stasis of various degree existed in patients suffering from exophthalmos. Investigations were made regarding microcirculation, hemodynamics, and blood rheology of the patients studied. Abnormal vascular morphology in the microcirculation of the nail fold was found. The blood flow was slow and nonlinear, and stasis was observed at the tip portion of the vascular loops. After acupuncture, the abnormal mode of blood flow, its velocity, and stasis within the loops showed significant improvement when analyzed statistically. The change of blood flow in the orbit of 66 eyes with exophthalmos was examined according to the principle of blood flow impedance, and abnormal waves were found to be present in 82%, When the wave amplitude, time of inflow, and the perfusion index of the exophthalmic eyes were compared after acupuncture treatment "with those of 100 normal eyes, the differences were all significant statistically (P< 0.05-0.01). Three of the five cases studied rheologically showed a state of hypercoagulability. With the above data and observation, we have arrived at the preliminary conclusion that the exophthalmos that remained after control of hyperthyroidism bears a close relationship to circulatory stasis, and that acupuncture therapy is effective in the treatment of this condition.